by Nanci Hellmich, USA TODAY

by Nanci Hellmich, USA TODAY

The case of the 10-year-old girl in Philadelphia who needed a transplant with adult lungs to survive tugged at the nation's heartstrings.

Every day there are similar dramas playing out around the country with patients competing for the few available hearts, kidneys, livers, lungs and other lifesaving organs.

In the wake of the legal and ethical wrangling the case entailed, many wonder what can be done to change this situation. Getting more people to register as donors is one avenue, but some say it's easier said than done, so other ideas are being debated.

"The one thing that the American public can do to help people like Sarah (Murnaghan) is to register to be a donor," says David Fleming, president and CEO of Donate Life America, a national non-profit advocate for organ, eye and tissue donation.

Registering to be a donor "is a gift," says Art Caplan, head of the division of medical ethics at New York University Langone Medical Center. "We rely on voluntary choice and altruism. There is no money, payment or incentive to do this."

Most polls show that more than 90% of people say being an organ donor is the right thing to do, Fleming says. But only about 109 million Americans - about 45% of adults over 18 - are registered as organ, eye and tissue donors in their states, he says. In the absence of a person being a registered donor, families are asked at the time a loved one dies to consent to organ donation. Consent rates are significantly lower in such situations.

There aren't nearly enough donors to meet transplant needs. Nearly 120,000 men, women and children await organ transplants in the USA. "We have 18 people dying every day, just waiting for an organ to save their lives," Fleming says.

Most people volunteer to be a donor when they are getting a driver's license at their state's Department of Motor Vehicles, and people can go online (donatelife.net) 24/7 to sign up, Fleming says. After they volunteer, their name is added to an electronic registry as a consented donor to be used for transplants.

Even if people register, chances are they'll never be a donor because they died from an illness or an accident that left their organs too damaged for anyone else to use, Fleming says. An organ donor is typically brain dead and on a ventilator, which is only about 1% of all deaths, he says.

Organ donors are usually people who die of head injuries resulting from such events as car accidents, gunshot wounds, swimming pool accidents or child abuse, and they're on life support, Caplan says.

Donors can't have infectious diseases, cancer or be over 90 years old, and when they are dying, they need to be on life support so the blood and oxygen is still getting to their organs, he says. "It's relatively hard to be an organ donor because most people don't die on life support, and even when they do die on life support, they are usually too sick to have healthy organs to donate."

Some experts such as Caplan suggest the nation should consider changing the way it thinks about all this.

Instead of asking people to "opt into" the system by indicating their willingness to be a donor, these experts say the assumption should be that everyone in the country should be considered a donor unless they "opt out." The latter proposal is called presumed-consent or default-to-donation.

"We have this voluntary opt-in system, but why don't we shift the system and have a default-to-donation system?" Caplan says.

He says other countries such as Spain have had some success with getting more organs with an opt-out system. Before the USA goes to this method, he says, it should be tested in a few states.

Joshua Sonett, chief of General Thoracic Surgery at New York-Presbyterian Hospital/Columbia University Medical Center, says there would be plenty of organs if we had an "opt-out" system.

Fleming doesn't like the idea. "We would be moving from a system where we honor your wishes to be a donor to an (opt-out) system where it's the government's right to procure your organs unless you opt out." Fleming says many people would think this violates their personal rights, which could send them rushing to sign opt-out forms.

He says European countries using the opt-out method "are not doing any better than we are. I truly believe it would be a disaster if it happened here. I think we'd have millions and millions of people register not to be donors."

Fleming says the biggest obstacle to having more donors is procrastination. "No one thinks they are going to die anytime soon, so we think we have plenty of time to sign up."

And there's the problem of fear. Some are afraid the medical profession won't work as hard to save them if they've signed up as a donor, and that's simply not true, he says.

Many decisions about being an organ donor are made at the DMV and the ICU, which are not the best places, he says. It's better to talk about it at home with your family, he says. "It's a serious decision. I don't think it's an easy decision for everyone."

He asks people to keep this in mind: Donors can save seven lives with their organs going to different people, and the tissues from a donor can improve the lives of up to 50 people.

If you haven't registered to be an organ donor or aren't sure if you have, go to donatelife.net/register-now/, then click on your state and sign up, Fleming says.